Harry Richard Lamb

Harry Richard Lamb
University of Southern California | USC · Department of Psychiatry and Behavioral Sciences

MD

About

159
Publications
42,845
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Introduction
Dr. Lamb became Professor of Psychiatry at the University of Southern California School of Medicine in 1976, a post he held until 2006 when he became Professor Emeritus. His publications include: 6 books, and over 140 peer reviewed articles. Dr. Lamb has written about the plight of persons who had spent many years in state hospitals and were now residing in substandard living situations “in the community,” about the homeless mentally ill and the plight of the mentally ill in jails and prisons.

Publications

Publications (159)
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Schizophrenia is one of the most important and expensive diseases in the United States. A primary responsibility for developing better drugs for this disease lies with the pharmaceutical industry and the National Institutes of Mental Health (NIMH). Using ClinicalTrials.gov, the online registration for drug and other clinical trials, we assessed tre...
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This article begins with the history of the rise and fall of the state hospitals and subsequent criminalization of persons with serious mental illness (SMI). Currently, there is a belief among many that incarceration has not been as successful as hoped in reducing crime and drug use, both for those with and those without SMI. Moreover, overcrowding...
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Treating persons with serious mental illness is a complex and challenging endeavor. One intervention that has received little attention in recent years is the need for asylum. Asylum means a sanctuary, a place that lowers levels of stress and provides protection, safety, security, and social support, as well as an array of treatment services. The c...
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When Lionel Penrose published his study, “Mental Disease and Crime: Outline of a Comparative Study of European Statistics”¹ 75 years ago, he had no way of knowing that his research would still be the subject of interest, and even controversy, in major psychiatric journals 3 quarters of a century later.² Penrose found an inverse relationship between...
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Decarceration (decreasing the number of persons incarcerated in U.S. jails and prisons) has begun. It is estimated that more than 350,000 persons with serious mental illness (SMI) are among those incarcerated in the United States and that many thousands of them will probably be among those released. Currently, the prison population in general is be...
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Watching a loved one fall into the grip of severe mental illness can be painful and terrifying in equal measure. And yet sometimes, to the chagrin and astonishment of those who want to help the ill person find a way back to the life he once had, pleas to seek treatment are met with emphatic insistence that everything is fine. At some point, when th...
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Geller and Lee use their study of Findings Letters, sent by the United States Department of Justice (DOJ) to the states after investigations of state psychiatric hospitals, as a way to study the investigation process itself. Their article serves as a useful program evaluation for DOJ and suggests important ways in which the investigations could be...
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In recently published articles, there has been an underemphasis on the role serious mental illness (SMI) plays in causing persons to be in the criminal justice system. Increasing attention has been paid to other factors, including criminogenic needs. While these needs may be present and contribute to criminal behavior, persons with SMI who are at g...
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Persons with serious mental illness are a heterogeneous group. A large majority recognize that they are mentally ill, and they are treatment adherent, often able to work, and do not have major problems with substance abuse and violence. However, a substantial minority exists who receive little attention in the literature. They may not believe that...
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While the great majority of persons with severe mental illness (eg, schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, and other psychotic disorders) are not violent, there is a small minority who may become aggressive when stressed.1 For instance, in a US national study of persons with schizophrenia and violent b...
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A retrospective study of inmates with severe mental illness in a large, urban county jail aimed to obtain information about their psychiatric and criminal histories and status, the psychiatric services they used while incarcerated, and the challenges they might present in psychiatric treatment after release. The authors ascertained demographic char...
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This study examined outcomes during a one-year follow-up for persons who were discharged from a locked intermediate care facility in an urban area in California. The purpose of this study was to determine the extent to which persons with severe mental illness can be successfully transferred from an intermediate care facility to lower levels of care...
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Far-reaching structural changes have been made in the mental health system. Many severely mentally ill persons who come to the attention of law enforcement now receive their inpatient treatment in jails and prisons, at least in part, because of a dramatic reduction of psychiatric inpatient beds. While more high-quality community treatment, such as...
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The author agrees that McDermott and colleagues present evidence that may support and ethically facilitate clinical research in the forensic population. Such research is sorely needed if we are to better understand and find new ways to help this population.
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There is an increasing number of severely mentally ill persons in the criminal justice system. This article first discusses the criminalization of persons with severe mental illness and its causes, the role of the police and mental health, and the treatment of mentally ill offenders and its difficulties. The authors then offer recommendations to re...
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With deinstitutionalization and the influx into the community of persons with severe mental illness, the police have become frontline professionals who manage these persons when they are in crisis. This article examines and comments on the issues raised by this phenomenon as it affects both the law enforcement and mental health systems. Two common-...
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The authors discuss what can be learned from our experience with deinstitutionalization. The deinstitutionalization of mentally ill persons has three components: the release of these individuals from hospitals into the community, their diversion from hospital admission, and the development of alternative community services. The greatest problems ha...
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Examines both positive and negative effects of the mass movement of persons with severe mental illness out of the state hospitals and into the community. The chapters in this text address the following issues: the use of community alternatives to state hospitalization; the large numbers of persons with severe mental illness who are in the criminal...
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Objective: The presence of severely mentally ill persons in jails and prisons is an urgent problem. This review examines this problem and makes recommendations for preventing and alleviating it. Methods: MEDLINE, Psychological Abstracts, and the Index to Legal Periodicals ana Boob were searched from 1970, and all pertinent references were obtained....
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Deinstitutionalization, which began in the mid-1950s, has had dramatic effects. It has decreased the number of occupied state hospital beds from 339 to 29 per 100,000 population. The plight of the new generation of chronically and severely mentally ill persons has posed the most serious problem: these individuals no longer receive life-long hospita...
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Objective: Very large numbers of severely mentally ill persons now fall under the jurisdiction of the criminal justice system. A number of conditions are placed on those who are returned to the community, including specific ones related to treatment. This paper reviews the principles and practice of forensic outpatient mental health treatment. Me...
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Objective: The study examined whether outreach teams of mental health professionals and police officers could assess and make appropriate dispositions for psychiatric emergency cases in the community, even in situations involving violence or potential violence. The study also assessed whether such teams could reduce criminalization of mentally ill...
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Objective: The authors examined the outcomes of mental health consultation provided to a municipal court and the court's resulting interventions for mentally ill persons who committed minor crimes. One aim of the consultation program was to avoid criminalization of mentally ill people who committed minor offenses. Methods: Clinical and forensic...
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In California conservatorship is a legal mechanism that allows an individual or agency (the conservator) to act on behalf of a gravely disabled mentally ill person (the conservatee) to determine what arrangements are necessary to provide adequate food, clothing, shelter, and treatment, including hospitalization when indicated. Conservatorship can p...
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Psychiatric rehabilitation, which is aimed at helping persons who have long-term mental illness to develop their capacities to the fullest possible extent, has been an integral part of psychiatric treatment in the U.S. since the beginnings of moral treatment in the early 19th century. The author outlines broad historical developments and prominent...
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Community treatment of mentally disordered offenders is conducted under a variety of circumstances. This chapter focuses on those offenders who remain under the jurisdiction of the criminal justice system, such as individuals who are given probation by the court with one of the conditions being mandatory outpatient treatment. Another instance is in...
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OBJECTIVE: Very large numbers of severely mentally ill persons now fall under the jurisdiction of the criminal justice system. A number of conditions are placed on those who are returned to the community, including specific ones related to treatment. This paper reviews the principles and practice of forensic outpatient mental health treatment. METH...
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No problem has been of greater concern to mental health professionals, families, and people with mental illness than the stigma of mental illness in our society. Much effort has been expended in demonstrating that mental illnesses are comparable to physical illnesses, in showing that mentally ill persons can take their place in society like any oth...
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The presence of severely mentally ill persons in jails and prisons is an urgent problem. This review examines this problem and makes recommendations for preventing and alleviating it. MEDLINE, Psychological Abstracts, and the Index to Legal Periodicals and Books were searched from 1970, and all pertinent references were obtained. Clinical studies s...
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Those who visit mental health programs in this and other countries often hear program directors say that by developing extensive and high-quality cornmunitv-based programs, they have reduced their long-term hospitalized patients to a remarkably low nuiither or have even eliminated the need for hospitals. Howevei; a clinician who has the opportunity...
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Objective: The study examined a 95-bed locked community facility (an institute for mental disease), one of 40 such facilities in California to which patients with increasingly difficult problems in management have been referred over the past few years as an alternative to more highly structured state hospitals. The purpose was to determine the cha...
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Mental health consultation is provided to a municipal court that recommends court-mandated interventions for mentally ill persons who have committed minor crimes. This study demonstrates that a significantly better out-come results when the judge not only mandates but monitors mental health treatment.
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It was necessary for this book to be written, because those who practice psychotherapy and those who are treated by it need to know what psychotherapy is and is not. Toward that end, the author examines in great detail and puts into perspective the ideologies of the four most influential schools of psycho-social thought: psychoanalysis, behaviorism...
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After a brief history, this chapter describes important modalities and models of psychiatric rehabilitation.
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The number of state hospital beds nationwide has been reduced to 40 per 100,000 population; in California, nonforensic state hospital beds have decreased to 8.3 per 100,000. The main effects of this reduction are becoming more evident. Most seriously affected have been the new generation of chronically and severely mentally ill persons who have rea...
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People with chronic mental illness present complex challenges for the design of health care financing reforms. In this position statement from the committee on psychiatry and community of the Group for the Advancement of Psychiatry, the authors describe chronic and severe mental illnesses as psychiatric illnesses that require acute and ongoing psyc...
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Deinstitutionalisation is at an advanced stage in the US, both in duration, and in reduction in state hospital beds. The new generation of chronically and severely mentally ill persons has posed the greatest problems. They no longer receive life-long hospital admission and thus permanent asylum from the demands of the world. Resistance to treatment...
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To make appropriate treatment and public policy recommendations to address the problems of homeless mentally ill persons, it is important to differentiate the homeless mentally ill population from the homeless population in general. Effective advocacy for homeless mentally ill persons should have realistic goals that address the specific needs of t...
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The authors examined the conservatorship process in California by studying a group of psychiatric patients for whom conservatorship was sought; their goal was to determine its effectiveness both during and after the period of conservatorship. The subjects were 60 county psychiatric hospital inpatients 18-60 years old for whom temporary (30-day) con...
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Progress in alleviating the plight of the homeless mentally ill has been very slow and disappointing. After reviewing the needs of the homeless mentally ill, the author makes recommendations for immediate action. Extensive case management services should be implemented rather than simply discussed. All incompetent and/or dangerous or gravely disabl...
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Fifty-three homeless mentally ill patients were studied by two psychiatrists in a treatment setting in which data could be gathered from family members and other third parties as well. All the patients were severely mentally ill when the homelessness immediately preceding the current admission began. For the study group, the disabling functional de...
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In this paper a group of knowledgeable individuals with expertise in psychiatric education present their recommendations for a basic psychiatric residency curriculum concerning the chronically mentally ill. The proposed curriculum consists of knowledge, skill, and attitude educational objectives, as well as clinical experiences, faculty supervision...
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The homeless mentally ill have become one of the greatest problems of present-day society. The American Psychiatric Association's Task Force on the Homeless Mentally III concluded that this is not the result of deinstitutionalization per se but of the way it has been carried out; homelessness among the chronically and severely mentally ill is sympt...
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Describes how work therapy with schizophrenic patients can be an extremely effective activity that not only helps these patients remain in the community, but also makes their lives more meaningful. Work therapy contributes to patients' mental health by increasing their feelings of self-esteem and mastery over their lives and often leads to their ac...
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Dr Koran and his colleagues are to be congratulated for their article in this issue.1 In a well-designed study, they have demonstrated that almost half the patients in a large state public mental health system had an important physical disease, and that almost half of these diseases had gone unrecognized by that mental health system. This included...
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The authors, reflecting on their combined experience of many years, comment on the status and direction of public psychiatry in an era of deinstitutionalization.
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Discusses problems associated with deinstitutionalization that have affected the course of psychiatric service delivery and comments on implications for future delivery of psychiatric services. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Court-mandated outpatient treatment for offenders found not guilty by reason of insanity is an alternative form of treatment in which insanity acquittees may be released into the community after serving part of their commitment in a forensic hospital. Working with this difficult population requires a close liaison with the criminal justice system a...
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Much has gone wrong with deinstitutionalization. To get back on course, the author says, we should acknowledge that while deinstitutionalization was a positive step, it has gone too far--that some of the long-term mentally ill now in the community need highly structured residential care. The long-term mentally ill should be made the highest priorit...
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The authors conducted a 5-year follow-up study of 79 persons found not guilty by reason of insanity who were referred to and accepted for court-mandated community outpatient treatment. This was a severely mentally ill and violent group with extensive experience in both the criminal justice and mental health systems. This program was not without ris...
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In training mental health professionals to work with long-term mentally ill persons, the importance of the one-to-one relationship needs to be emphasized. As advocated here, this should be a reality-based, problem solving approach. No part of this work is more important than giving these persons a sense of mastery over their internal drives, their...
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Of 85 persons (38% of those found incompetent to stand trial in Los Angeles County in 1983), 92% were currently charged with felonies and 62% with crimes of violence. Eighty-seven percent had a history of serious physical violence against persons and 68% had prior felony arrests. This study indicated that in this jurisdiction, incompetency to stand...
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• Of 85 persons (38% of those found incompetent to stand trial in Los Angeles County in 1983), 92% were currently charged with felonies and 62% with crimes of violence. Eightyseven percent had a history of serious physical violence against persons and 68% had prior felony arrests. This study indicated that in this jurisdiction, incompetency to stan...
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Research on expressed emotion in the families of schizophrenic patients has seemed to offer a new perspective on environmental factors that cause relapse in schizophrenia. A review of the literature, however, reveals that while expressed emotion may predict relapse, there is no evidence that it causes relapse. Nor does the evidence support the cont...
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The complexities of the Tarasoff and Hedlund cases extended the liability of clinicians in situations in which patients communicate threats of harm to third parties. Because of these and other rulings, clinicians need to follow guidelines for staged responses to such threats and to document and substantiate their decisions.
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Until recently, most mental health professionals and society generally have been reluctant to provide the community care and treatment needed by schizophrenics. To understand this, some of the recurrent and underlying issues that often impede treatment are briefly discussed: our expectations of schizophrenics and of ourselves; how to derive gratifi...
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The homeless mentally ill have become one of the greatest problems of present-day society. The American Psychiatric Association's Task Force on the Homeless Mentally Ill concluded that this is not the result of deinstitutionalization per se but of the way it has been carried out; homelessness among the chronically and severely mentally ill is sympt...
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Full-text available
The homeless mentally ill have become one of the greatest problems of present-day society. The American Psychiatric Association's Task Force on the Homeless Mentally III concluded that this is not the result of deinstitutionalization per se but of the way it has been carried out; homelessness among the chronically and severely mentally ill is sympt...
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Three areas of legal change have had major effects on the chronic mentally ill: substantive and procedural alterations in civil commitment laws, the limited implementation of a constitutionally based right to treatment, and the partial recognition of a right to refuse treatment. After discussing these changes, the authors make recommendations they...
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The implementation of deinstitutionalizartion reflects deeply held negative attitudes about chronically mentally ill persons and has contributed to the large numbers of psychiatrically disabled indiutduals on our city streets.
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The family self-help movement in schizophrenia is in danger of losing its effectiveness, the authors believe. Many in the movement seem overly concerned with being accepted by professionals and others, which means that they become less single-minded in their advocacy for their relatives and for their own needs. Family groups are having difficulty m...
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Comments on the study by G. N. Braucht and M. W. Kirby (see record 1987-28267-001) and suggests that it highlights the importance of systematically studying the chronically mentally ill. (0 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This article reflects the author's view on responses to the American Psychiatric Association's Task Force Report on the Homeless Mentally Ill. He states that the chronically and severely mentally ill are not proficient at coping with the stresses of this world and are vulnerable to eviction from their living arrangements, sometimes because of inabi...
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Management of Chronic Schizophrenia. By CatonC. L. M.. (Pp. 210; £19.00.) Oxford University Press: New York. 1984. - Volume 14 Issue 4 - H. Richard Lamb
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Although homelessness among the chronically mentally ill is closely linked with deinstitutionalization, it is not the result of deinstitutionalization per se but of the way deinstitutionalization has been carried out. The lack of planning for structured living arrangements and for adequate treatment and rehabilitative services in the community has...
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Deinstitutionalization of the chronically mentally ill does not mean they no longer need social support, protection, and relief from the pressures of life--in other words, asylum and sanctuary. The authors address the questions of why asylum should be provided, for what patients, the relationship between asylum and rehabilitation, and the implicati...
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There is an urgent need for psychiatric services for mentally ill inmates in local jails. The authors recommend that a psychiatric team be established inside the jail to provide short-term crisis evaluation, disposition, and treatment; that special training be provided for jail booking personnel in the recognition of psychiatric problems during the...